Scleral perforation wounds

The diagnosis of a penetrating wound of the sclera is sometimes difficult to establish if there is no radiopaque or visible through the pupil and rock body inside the eye, there is no gaping of the wound edges that are covered by edematous or blood-soaked conjunctiva, prolapse of the internal membranes or vitreous body.

A penetrating wound of the sclera, unlike wounds of the cornea, behind which there is a fairly deep anterior chamber, can very rarely be uncomplicated, i.e. not be accompanied by damage to deeper tissues (uveal tract, retina, vitreous body). During surgical treatment, it is possible to establish the depth and extent of the scleral wound. Under the control of an operating microscope, all branches of the wound are followed - to areas of undamaged sclera. Since scleral wounds have their own conjunctival coating and are in deep contact with the vascular tract, they stick together faster than corneal wounds, never fistulate and are surrounded by newly formed vessels early.

Surgical treatment begins with the application of 1-2 frenal sutures on those rectus muscles, the tightening of which can bring the wound area into the projection of the eye slit. Then the conjunctival wound is freed from blood clots, fibrin films and mucus using cotton swabs and smooth tweezers. When the wound configuration is fully determined, the main (shaping) sutures are applied from nylon 04-05. First of all, the corners of the wound are brought together, the flaps of the sclera are tightened, or simply the extended wound is divided into shorter sections. Then the loops of these sutures are spread, the fallen tissues are cut off with sharp micro scissors and the preliminary sutures are immediately tied, which prevents the contents from falling out. Nodal sutures from silk 08 are applied to the still unsutured branches of the wound. If the wound is very large and extends to the posterior pole of the eye, then the sutures are applied in stages.

Penetrating wounds of the sclera with vitreous prolapse. and with a small wound of the sclera it is necessary to excise the prolapsed vitreous, therefore during surgical treatment the scarring stroma of the vitreous body is excised behind the retina in the area of the wound. This is achieved by moderate (by 2-3 mm) compression of all membranes over the sealed wound by suturing an episcleral seal made of silicone rubber. Folding sutures made of braided lavsan or myron are carried out no closer than 4-5 mm from the edges of the wound, and deep enough, after restoring the turgor of the eye with any of the vitreous substitutes with the addition of antibiotics and corticosteroids. This procedure reduces the likelihood of subsequent traction retinal detachment.

A flap of preserved dura mater is placed on the surface of the filling and the sclera in the area of the wound and secured with 3-4 08 silk sutures to the episclera.

[ 1 ], [ 2 ], [ 3 ], [ 4 ]

Perforating scleral injury with tissue defects

If a defect is found during the treatment of the scleral wound, it can be placed with a piece of tissue (sclera, dura mater) of the appropriate shape. A defect in the sclera indicates severe damage to the entire eye, including the retina, so the intervention is more likely to be a cosmetic, organ-preserving procedure aimed at restoring visual functions in the damaged eye. The complexity of this intervention is that the wound is sutured with a noticeable forced deviation of the eye from its normal, average position in the orbit, and this deforms the fibrous capsule, increases the turgor of the eyeball and ultimately provokes a massive depression of the vitreous body from the gaping wound.